Hyperosmolar Hyperglycemic State (Severely Elevated Glucose)
Description
Occurs when the glucose in the blood becomes very high, at times over 1000 mg/dl. This disorder is usually seen in Type 2 diabetics. It used to be called Hyperosmolar Nonketotic Coma (HONK) but the name was changed because unconsciousness (coma) is seen in less than 20% of patients. The disease is very serious and 15% of those afflicted can die. Patients are very dehydrated and can have dangerously low blood pressures. An infection in a patient with diabetes is many times the cause although other co-existing diseases can result in the very high glucoses. The disorder can occur at any age but is most commonly seen in older patients with an average age of 70. In 30% of the patients the disease is the first sign of diabetes. Patients need immediate treatment.
Symptoms
Confusion, lethargy, coma, seizures, visual problems, weakness on one side of the body, numbenss on one side of the body.
Tests
A history and physical will be done. Other tests will be performed to determine the cause of the elevated glucose. Tests to look for damage to other organs such as the kidneys will be done as well.
- Chem 12
- CBC
- Ketones
- EKG
- UA
- X-Ray
- ABG
Treatment
Patients require immediate treatment with intravenous fluids and insulin. Treatment of the cause of the elevated glucose such as infections need to be performed as well. Most patients require admission into an intensive care unit.
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